Provider Demographics
NPI:1730410911
Name:PITTS, KATHLEEN MARY (PTA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:PITTS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MACIVER
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1230 TAYLOR LANE EXT
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6159
Mailing Address - Country:US
Mailing Address - Phone:239-303-0957
Mailing Address - Fax:
Practice Address - Street 1:1230 TAYLOR LANE EXT
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6159
Practice Address - Country:US
Practice Address - Phone:239-303-0957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19724225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA19724OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH